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A second series of chemotherapy – suggestions?


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When I was first diagnosed with stage IV adenocarcinoma the oncologist said palliative treatment was all I could expect. Like most of you, the diagnosis was very unexpected because I felt pretty good. I asked if there were any clinical trials that might be worthwhile and ended up in a clinical trial of six 21 day cycles of gemcitabine, carboplatin and velcade at U.C. Davis in California. I handled the treatment well and at the conclusion the tumors had shrunk significantly.

Shortly after the trail, I found a new oncologist who thought radiation therapy might finish killing the tumors. He said he would give me close to the maximum rads and cook it – this sounded good to me! About 5 weeks after 40 radiation treatments to the lung and 35 treatments to the tumor on my adrenal gland, a PET scan shows a mean (average) SUV (Standard Update Value) of 3.5 in the lung area and a mean SUV of 5.8 to the adrenal tumor. As John pointed out in his post of Sept. 24, 2004, 2.5 is the cutoff when something is considered malignant. This radiation oncologist also thought my CEA was a pretty good marker at 62.2 when we started radiation. After radiation it is 46.0 – I think I read that anything over 5 indicates cancer. So, the battle continues.

I’ve recently had a CT, PET and MRI scan. The oncologist feels that a bone scan is unnecessary because if I had mets to the bone, indications would have shown up on the recent blood test. I consider myself lucky that I don’t have any other mets to be worried about at this time – just two tumors that are still fighting to overtake me.

Sorry for the long story, but the oncologist is now recommending 4 more cycles of chemotherapy. He is referring me to another oncologist. I’m trying to gather information (before seeing the new oncologist) on what chemotherapy drugs might work best at this point of my treatment? Does anyone have any ideas, experience with a second round of chemotherapy, or other treatment thoughts? I don’t care about side affects, I just want drugs that might work well against the cancer.

Thank you,

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Hi and welcome!

Sounds like you are taking an aggressive approach to this illness, and it is paying dividends - that's great to hear!!

My Mum's first line treatment consisted of cisplatin and gemcitibine. She did this for 6 months, and tolerated it pretty well, although her bone marrow took a bit of a hammering. There was moderate shrinkage of the primary tumour, and then, after a 3 month break from chemo, progression of disease. Mum has just commenced second line treatment of taxotere and PI-88 (an experimental anti-angiogenesis agent), and so far is experiencing very little in the way of side-effects. She will be having a scan at the end of November to determine the effect of treatment, and of course, we remain very hopeful. Mum was asymptomatic at the time of diagnosis, and apart from the odd niggle in her rib-cage, remains that way.

I wish you all the best in your continuing battle. Keep us posted!


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I've had 2 types of chemo, taxol/carboplatin and taxotere. Taxol/carbo did not shrink anything, taxotere showed some slight shrinkage, but after being off of it for a couple of months, progression. I then went on Iressa which has held me stable for 4 months with the lung tumor. Unfortunately, I was just diagnosed with 6 brain mets and completed 10 rounds of wbr, but am still continuing with the Iressa.

It is worth looking in to. It has worked for many of us on the boards.

Sorry you have to be here and hoping for a good treatment that brings shrinkage to you!


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Welcome, although I am not stage 4, if you are strong enough to handle it take it!

I did radiation and taxol/carbo, then I was to do 4 additional full strength chemo, did taxotere and chould not take the pain then did gemzar/carboplatin and was allergic to it. Only had 2 out 4 treatments.

If you can take it........do the additional treatments.

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Welcome, ReillySmith.

I wish you well in your fight.

There have been some discussions about first line and second line chemos, which maybe you could find by keyword.

The other thing is to ask Dr. Joe what he knows.

I am curious, why did your first oncologist refer you out?

Keep us posted,


Prayers always,


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Welcome! Would need more info about your case. What were the locations of your disease? Is the adrenal gland the only metastatic site? Are you a current/former/never smoker? Do you have any residual toxicity from your previous treatment (esp. do you have any neuropathy from the velcade)? Also how far after radiation was the PET scan done?

Taxotere is a very active drug in second line lung cancer that would have a good likelihood of not having cross resistance to your prior treatments. If you are a never smoker then I would sure be interested in Iressa (or Tarceva if you can find a trial). First question though is whether you should start treatment now or wait to see if the radiation continues to have beneficial effect. Tumors often continue to shrink for months after radiation and interpretting a PET after radiation is both difficult and controversial. I am not convinced that you can really interpret disease activity for a minimum of 3 months after radiation is completed.

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Wayne was just given the good news on Wednesday at the Cancer Treatment Center of America in Tulsa that his lung tumor has shrunk some from 3 treatments of Gemzar. He will continue with this treatment as long as it's working.

I'm hearing lots of good things about Alimta-the new chemo drug just approved by the FDA. Some patients are experiencing 30-50% reduction in their tumors. It sounds wonderful and will give Wayne something else to try if the Gemzar doesn't keep working.


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